Abstract
Purpose :
To evaluate the outcomes of combined Descemet stripping automated endothelial keratoplasty (DSAEK) and iris-sutured IOL procedures in eyes with aphakic (ABK) or pseudophakic bullous keratopathy (PBK) and to perform a literature review of published cases, including alternative fixation methods.
Methods :
This retrospective case series included eyes that underwent combined DSAEK and iris suture IOL fixation procedure between January 2013 to April 2019 in an academic tertiary referral center. Baseline data, including patient demographics and indications for surgery were identified. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and intraocular pressure (IOP) were evaluated at baseline as well as at post-operative month one (POM1), month three (POM3), and between six to twelve months after surgery (POM6-12). Intra-operative and post-operative complications were also recorded, including endothelial graft survival and IOL centration and stability.
Results :
Sixteen eyes were identified and included in this study, with an average follow-up of 22.4+21.4 months. The mean pre-operative UCVA improved from 1.65±0.69 LogMAR to 1.48±0.67 LogMAR at POM1, to 1.49±0.57 at POM3, and to 1.31±0.83 at POM6-12. Mean BCVA improved from 1.56±0.68 LogMAR to 1.32±0.74 LogMAR at POM1, to 1.10±0.81 at POM3, and to 0.96±0.90 at POM6-12. A higher IOP was noted at POM1 and POM3 compared to baseline (13.58±8.51 mmHg and 11.70±7.28 mmHg vs 11.44±5.25 mmHg pre-operatively). Early IOP spike was noted in three cases. One eye developed glaucoma post-operatively. There were two case of DSAEK graft decentration and four cases of graft detachment, necessitating re-bubbling during the follow-up period. One case of graft failure and another with graft rejection were observed. There were no cases of post-operative IOL displacement.
Conclusions :
Iris suture IOL fixation procedure combined with DSAEK is a safe and effective method to manage eyes with ABK and PBK. Iris suture-fixation of an IOL in such cases is strong enough to sustain the manipulation required for corneal procedures.
This is a 2020 ARVO Annual Meeting abstract.